Early renal function post-liver transplantation is predictive of progressive chronic kidney disease.
OBJECTIVE
With improvements in long-term results after liver transplantation, chronic kidney disease (CKD) has become a highly relevant problem. The early measurement of the glomerular filtration rate (GFR) can identify those patients who are at risk of developing CKD years after liver transplantation. The aims of this study were to describe the prevalence of CKD 5 years after liver transplantation, to study the correlation between measured GFR early after transplantation and late renal function and to identify patients at risk of developing late CKD after liver transplantation.


METHODS
A total of 152 patients who were at least 5 years post-liver transplantation were studied. Measured GFR with Chromium EDTA or iohexol clearance was followed-up for 5 years (n 52) and 10 years (n 41).


RESULTS
The overall decrease in measured GFR was 36% after 5 years and 42% after 10 years. Eight patients (5%) required renal replacement therapy. GFR levels pretransplantation showed a poor correlation with later renal function (at 5 years). The GFR measured at 3 months and 1 year post-transplantation correlated well with measured GFR at 5 years post-transplantation. Multivariate analysis showed that measured GFR of less than 30 ml at 3 months post-transplantation was significantly associated with CKD at 5 years post-transplantation.


CONCLUSIONS
GFR levels below 30 ml/min/1.73 m2 at 3 months post-liver transplantation are associated with the development of later CKD Stage 4-5 long after liver transplantation. The importance of this finding is the possibility of identifying at an early stage those individuals that may benefit from early implementation of calcineurin sparing or a withdrawal regimen with the goal of preserving long-term renal function.
Herlenius
Gustaf
G
Department of Transplantation and Liver Surgery, Sahlgrenska University Hospital, Göteborg, Sweden. gustaf.herlenius@gmail.com
Fistouris
Johan
J
Olausson
Michael
M
Felldin
Marie
M
Bäckman
Lars
L
Friman
Styrbjörn
S
D002614:Chelating Agents / Q000493:pharmacokinetics; D003287:Contrast Media / Q000493:pharmacokinetics; D018450:Disease Progression; D004492:Edetic Acid / Q000493:pharmacokinetics; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D006801:Humans; D007472:Iohexol / Q000493:pharmacokinetics; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D007677:Kidney Function Tests; D017093:Liver Failure / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors
D002614:Chelating Agents; D003287:Contrast Media; D007472:Iohexol; D004492:Edetic Acid